BUMETANIDE

BUMETANIDE
(byoo-met'a-nide)
Bumex
Classifications: fluid and water balance agent; loop diuretic;
Therapeutic: loop diuretic
; antihypertensive
Prototype: Furosemide
Pregnancy Category: C

Availability

0.5 mg, 1 mg, 2 mg tablets; 0.25 mg/mL injection

Action

Sulfonamide derivative structurally related to furosemide that causes both potassium and magnesium wastage. Inhibits sodium and chloride reabsorption by direct action on proximal ascending limb of the loop of Henle. Also appears to inhibit phosphate and bicarbonate reabsorption.

Therapeutic Effect

Produces only mild hypotensive effects at usual diuretic doses. Controls formation of edema.

Uses

Edema associated with CHF; hepatic or renal disease, including nephrotic syndrome. Has been used in management of postoperative and premenstrual edema, edema accompanying disseminated carcinoma, and mild hypertension. May be used concomitantly with a potassium-sparing diuretic.

Contraindications

Hypersensitivity to bumetanide or to other sulfonamides; anuria, markedly elevated BUN; hepatic coma; acute MI, ventricular arrhythmias; severe electrolyte deficiency; severe renal disease; diabetes mellitus; lactation; pregnancy (category C).

Cautious Use

Hepatic cirrhosis, as history of gout; history of hypersensitivity to furosemide; elderly.

Route & Dosage

Edema
Adult: PO 0.5–2 mg once/d, may repeat at 4–5 h intervals if needed (max: 10 mg/d) IV/IM 0.5–1 mg over 1–2 min, repeated q2–3h prn (max: 10 mg/d)

Administration

Oral
  • Give with food or milk to reduce risk of gastrointestinal irritation.
  • Administered in the morning as a single dose, either daily or by intermittent schedule. For some patients, diuresis is reportedly more effective when administered in two divided doses, morning and evening.
Intramuscular
  • Use undiluted solution for injection.
Intravenous

PREPARE: Direct/Continuous: Give direct IV undiluted (typical) or diluted for infusion with D5W, NS, RL.  

ADMINISTER: Direct: Give IV push at a rate of a single dose over 1–2 min.  Continuous: Use diluted solution and give at prescribed rate.  

INCOMPATIBILITIES Solution/additive: Dobutamine. Y-site: Fenoldopam, midazolam.

Diluted infusion should be used within 24 h after preparation.

  • Store in tight, light-resistant container at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Sweating, hyperventilation, glycosuria. CNS: Dizziness, headache, weakness, fatigue. CV: Hypotension, ECG changes, chest pain, hypovolemia. GI: Nausea, vomiting, abdominal or stomach pain, GI distress, diarrhea, dry mouth. Metabolic: Hypokalemia, hyponatremia, hyperuricemia, hyperglycemia; hypomagnesemia; decreased calcium, chloride. Musculoskeletal: Muscle cramps, muscle pain, stiffness or tenderness; arthritic pain. Special Senses: Ear discomfort, ringing or buzzing in ears, impaired hearing.

Interactions

Drug: aminoglycosides, cisplatin increase risk of ototoxicity; bumetanide increases risk of hypokalemia-induced digoxin toxicity; nonsteroidal antiinflammatory drugs (nsaids) may attenuate diuretic and hypotensive response; probenecid may antagonize diuretic activity; bumetanide may decrease renal elimination of lithium; sotalol may increase risk of cardiotoxicity.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 30–60 min PO; 40 min IV. Peak: 0.5–2 h. Duration: 4–6 h. Distribution: Distributed into breast milk. Metabolism: In liver. Elimination: 80% in urine in 48 h, 10–20% in feces. Half-Life: 60–90 min.

Nursing Implications

Assessment & Drug Effects

  • Monitor I&O and report onset of oliguria or other changes in I&O ratio and pattern promptly.
  • Monitor weight, BP, and pulse rate. Assess for hypovolemia by taking BP and pulse rate while patient is lying, sitting, and standing. Older adults are particularly at risk for hypovolemia with resulting thrombi and emboli.
  • Lab tests: Serum electrolytes, blood studies, liver and kidney function tests, uric acid (particularly patients with history of gout), and blood glucose. Determine values initially and at regular intervals; measurements are especially important in patients receiving prolonged treatment, high doses, or who are on sodium restriction.
  • Monitor for S&S of hypomagnesemia and hypokalemia (see Appendix F) especially in those receiving digitalis or who have CHF, hepatic cirrhosis, ascites, diarrhea, or potassium-depleting nephropathy.
  • Monitor patients with hepatic disease carefully for fluid and electrolyte imbalances which can precipitate encephalopathy (inappropriate behavior, altered mood, impaired judgment, confusion, drowsiness, coma).
  • Question patient about hearing difficulty or ear discomfort. Patients at risk of ototoxic effects include those receiving the drug IV, especially at high doses, those with severely impaired renal function, and those receiving other potentially ototoxic or nephrotoxic drugs (see Appendix F).
  • Monitor diabetics for loss of glycemic control.

Patient & Family Education

  • Report symptoms of electrolyte imbalance to physician promptly (e.g., weakness, dizziness, fatigue, faintness, confusion, muscle cramps, headache, paresthesias).
  • Eat potassium-rich foods such as fruit juices, potatoes, cereals, skim milk, and bananas while taking bumetanide.
  • Report S&S of ototoxicity promptly to physician (see Appendix F).
  • Monitor blood glucose for loss of glycemic control if diabetic.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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